Ingrown Toenail – OrthoInfo – AAOS

If you trim your toenails too short, particularly on the sides of your big toes, you may set the stage for an ingrown toenail. Like many people, when you trim your toenails, you may taper the corners so that the nail curves with the shape of your toe. But this technique may encourage your toenail to grow into the skin of your toe. The sides of the nail curl down and dig into your skin. An ingrown toenail may also happen if you wear shoes that are too tight or too short.

An ingrown toenail.

When you first have an ingrown toenail, it may be hard, swollen and tender. Later, it may get red and infected, and feel very sore. Ingrown toenails are a common, painful condition—particularly among teenagers. Any of your toenails can become ingrown, but the problem more often affects the big toe. An ingrown nail occurs when the skin on one or both sides of a nail grows over the edges of the nail, or when the nail itself grows into the skin. Redness, pain and swelling at the corner of the nail may result and infection may soon follow. Sometimes a small amount of pus can be seen draining from the area.

Ingrown nails may develop for many reasons. Some cases are congenital—the nail is just too large for the toe. Trauma, such as stubbing the toe or having the toe stepped on, may also cause an ingrown nail. However, the most common cause is tight shoe wear or improper grooming and trimming of the nail.

The anatomy of a toenail.

Nonsurgical Treatment

Ingrown toenails should be treated as soon as they are recognized. If they are recognized early (before infection sets in), home care may prevent the need for further treatment:

• Soak the foot in warm water 3-4 times daily.
• Keep the foot dry during the rest of the day.
• Wear comfortable shoes with adequate room for the toes. Consider wearing sandals until the condition clears up.
• You may take ibuprofen or acetaminophen for pain relief.
• If there is no improvement in 2-3 days, or if the condition worsens, call your doctor.

You may need to gently lift the edge of the ingrown toenail from its embedded position and insert some cotton or waxed dental floss between the nail and your skin. Change this packing every day.

Surgical Treatment

If excessive inflammation, swelling, pain and discharge are present, the toenail is probably infected and should be treated by a physician (see left image below). You may need to take oral antibiotics and the nail may need to be partially or completely removed (see middle image below). The doctor can surgically remove a portion of the nail, a portion of the underlying nail bed, some of the adjacent soft tissues and even a part of the growth center (see right image below).

Possible treatment options for an ingrown toenail.

Surgery is effective in eliminating the nail edge from growing inward and cutting into the fleshy folds as the toenail grows forward. Permanent removal of the nail may be advised for children with chronic, recurrent infected ingrown toenails.

If you are in a lot of pain and/or the infection keeps coming back, your doctor may remove part of your ingrown toenail (partial nail avulsion). Your toe is injected with an anesthetic and your doctor uses scissors to cut away the ingrown part of the toenail, taking care not to disturb the nail bed. An exposed nail bed may be very painful. Removing your whole ingrown toenail (complete nail plate avulsion) increases the likelihood your toenail will come back deformed. It may take 3-4 months for your nail to regrow.

Unless the problem is congenital, the best way to prevent ingrown toenails is to protect the feet from trauma and to wear shoes and hosiery (socks) with adequate room for the toes. Nails should be cut straight across with a clean, sharp nail trimmer without tapering or rounding the corners. Trim the nails no shorter than the edge of the toe. Keep the feet clean and dry at all times.

Proper and improper toenail trimming.

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Ingrown Toenail Removal | AAFP

Am Fam Physician. 2002;65(12):2557-2558

What is an ingrown toenail?

An ingrown toenail occurs when the nail edge is damaged, and the nail no longer fits properly into the side groove. The nail curls downward and digs into the skin, causing pain, swelling, redness, and drainage. Sometimes a piece of nail (called a lateral pointing spicule) becomes embedded in the side tissue, and the tissue becomes heaped up (hypertrophied).

What causes an ingrown toenail?

There are many causes for ingrown nails, but the two most common causes are poorly fitting shoes and improperly trimmed nails. Tight shoes compress the side of the nail and alter the fit of the nail in the groove. When nails are peeled off or torn, the edge of the nail can extend down into the corner of the nail groove. A torn nail can irritate the skin next to the nail, producing inflammation (swelling, pain, and redness) and sometimes infection.

Can ingrown nails be prevented?

Proper trimming of the nails is the best way to prevent an ingrown nail. Nails should be cut straight across, with the corners of the nail protruding from the end of the toe. Children or teenagers who play with their toes in bed at night can wear socks to bed to keep them from peeling or picking at their toenails.

How can I treat my painful nail?

When an ingrown toenail is mildly inflamed (slightly red and sore), soaking the foot in warm water and placing a piece of dry cotton under the corner of the nail may be all that is needed. If the ingrown toenail gets worse, the inflammation (pain, swelling, and drainage) may increase. An antibiotic ointment can be tried at this stage. After you see your doctor for the problem, he or she may try oral antibiotics. Surgical removal of part of the nail is often needed if the problem becomes worse.

What is the recommended surgical procedure for ingrown nails?

Surgical removal of an ingrown nail involves removing a small portion of the side of the nail and destroying the nail bed beneath. The toe is injected with a numbing medicine, and the toenail is cut to create a new, straight nail edge. The cells underneath the nail will try to grow a new nail, so they must be destroyed, thereby creating a permanently thinner nail. If there is heaped up (hypertrophied) tissue on the side of the toe, it must be removed. The toe is then bandaged until it completely heals (a few weeks).

What is the recovery time from my surgery?

You should keep your foot elevated for a few hours and rest on the day of the surgery; the next day, you can return to work or school. You should refrain from running or vigorous exercise for 2 weeks after the surgery.

Following Ingrown Toenail Removal

1. Antibiotic ointment will be applied to the toe immediately after the procedure. The ointment is soothing and helps the toe to heal faster. You should apply the antibiotic ointment twice daily until the wound is completely healed. We like the over-the-counter (nonprescription) antibiotic ointment Mycitracin Plus because of the numbing medication mixed in with the antibiotic.

2. You may shower the day after the surgery. Gently dry the area and apply antibiotic ointment after showering. Avoid baths, swimming, or soaking the toe for the next 2 weeks. Try to keep the toe clean and dry.

3. Your bandage will help to pad and protect the wound, while absorbing drainage from the wound. You can replace the bandage if blood or fluid soaks the bandage. Please keep the wound bandaged for at least 1 week after the surgery.

4. You may experience some pain after the procedure. If you experience discomfort, you can take ibuprofen (brand names: Advil, Motrin, Nuprin), three 200-mg tablets 3 times a day with food, and acetaminophen (brand name: Tylenol), two 325-mg tablets every 4 hours.

5. You should wear loose-fitting shoes or sneakers for the first 2 weeks after the procedure. Please avoid wearing high-heeled or tight-fitting shoes in the future. You should avoid running, jumping, or strenuous activity for 2 weeks after the surgery. Teenagers should not participate in physical education activities for 1 to 2 weeks after the procedure.

6. Infection may develop in the toe during the first few weeks after the surgery. Call your doctor if you develop increasing pain, swelling, redness, or drainage from the toe.

7. Trimming the nails straight across the top of the nail is the best way to prevent another ingrown nail from developing. The nail must not be cut down into the corners, or picked at, or torn off. If you should develop another ingrown nail, see your doctor early, because early treatment may prevent the need for surgery.

Ingrown nail – stages of the disease, methods of treatment

16.02.2021

There will be no doubt that this is a serious and not at all trifling problem only for those who know firsthand what excruciating pain occurs if the case is neglected.

Approximately 10% of the country’s population suffers from an ailment – an ingrown nail, in other words, onychocryptosis. Typically, the toenail grows into the soft surrounding tissue.

How does a nail work?

A horn formation (plate) is called a nail. The nail is located in the nail bed. At the root of the nail is a matrix – due to it, the nail grows. If the matrix is ​​damaged, then the nail will grow incorrectly or stop growing altogether. On the sides of the nail are skin folds, they are called the nail roller.

Causes of onychocryptosis

• genetic predisposition,
• overweight,
• wearing tight shoes,
• shoes with heels,
• incorrect pedicure,
• diabetes,
• vascular disease of the lower extremities,
• fungal diseases,
• non-observance of personal hygiene,
• injury

Most often, an ingrown toenail occurs in young people. They try, during a pedicure, to round off the corners of the nail plate as much as possible, thereby disrupting the natural growth of the plate, it begins to grow into the soft tissue.

Stages of the disease

• The first stage is redness around the nail, swelling and slight discomfort when walking.
• The second stage – part of the nail cuts into the skin, swelling occurs. A person experiences obvious pain and not only when walking.
• The third stage – in addition to pain in the focus of inflammation, purulent discharge appears. The nail thickens. The so-called “wild meat” appears – tissue grows.
• Fourth stage – soft tissue granulation occurs. The disease becomes chronic. Difficult to treat.

Consequences

If an ingrown toenail is not treated promptly, complications can occur. Inflammation can go to the bone (ostiomyelitis), up to gangrene and amputation of the toes.

At risk are people with diabetes, the elderly.

Prophylaxis

First of all, it is necessary to cut the nails correctly, the cut should be even (parallel to the nail roller), when carrying out a pedicure, it is necessary to hold the legs in a warm bath, and follow the rules of hygiene daily. Wear loose, comfortable shoes.

Conservative treatment

If the stage of the disease is first or second, then nail softeners are recommended. Orthopedic inserts, staples, springs, plates are also recommended. Devices are fixed on the nail in order to correct the deformation of the nail. The procedure is painless. Delivers a minimum of inconvenience. The use of cosmetic varnish is allowed. It is recommended to wear the devices for 3-4 months.

With fungal diseases, appropriate medications will help.

Laser treatment

Gentle, painless method. As a rule, the nail plate is not completely removed. Remove only the ingrown part of the nail. Also, the infected tissue is cleared by the laser, preventing the process of further inflammation.

Radio wave treatment

No less popular method than all the others. When using it, the immune properties of the skin and tissues increase. No bleeding, no scarring.

Surgical treatment

The most radical. The ingrown edge of the nail, the nail bed and part of the nail root dry out. Either a wedge-shaped resection of the nail plate or a selective resection of the nail matrix is ​​performed. In advanced cases, the nail is completely removed. The disadvantage of this procedure is that the nail plate is restored within six months.

ingrown nail

Ingrown nail problems. Prevention and treatment in Novosibirsk

With the advent of spring, many fashionistas can’t wait to change their winter boots for frivolous sandals, because they really want to demonstrate well-groomed toenails in open shoes! What girl and woman will refuse attractive summer shoes with spicy stilettos Shoe designers, given the whims of modern fashionistas, probably do not suspect that their elegant creations can cause unbearable suffering from an ingrown toenail. How to avoid it and what to do if you are faced with the problem of an ingrown nail, told Yuri Leonidovich Starkov , head of the department of outpatient surgery at the Central Scientific and Medical Center on Titov, surgeon of the highest category, candidate of medical sciences.

Model shoes do not cause unpleasant symptoms for all women – usually those who have a foot and first toe are not subject to bone deformity are lucky, but there are not very many such lucky women. Additional factors aggravate the situation: valgus deformity of the 1st finger, flat feet (transverse and longitudinal), overweight (including during pregnancy).

What to do, where is the exit? What should be done to prevent the development of an ingrown toenail? First of all, it is necessary to eliminate the root cause of the disease, namely:

Onychomycosis

The fact is that nail fungus destroys the connection between the inner edge of the nail plate and the nail bed. In this case, the nail plate corroded by the fungus is deformed and cuts into the periungual ridges.

Exit: Consultation and treatment with a dermatologist.

Unresolved bone pathology of the foot:

Foot deformity (congenital or acquired): flat feet, especially transverse, clubfoot, valgus deformity of the first toe, which contributes to improper distribution of weight on the toes when walking.
The main biomechanical cause of forefoot overload is excessive pronation, a constant companion of flat-valgus and “pseudo-sex” feet. This is a condition when the edge of the nail plate falls between the hammer (sole of the foot) and the anvil (shoes), constantly injuring the soft tissues of the nail phalanx, which leads to the development of an ingrown nail.

Output:

• use of thumb valgus correctors,
• wearing orthopedic shoes,
• application of orthopedic insoles.

Constant wearing of narrow, uncomfortable shoes with high heels, which leads to a shift in the center of gravity and overload of the forefoot foot section. 1 cm heel – 10% load on the forefoot.

8 cm heel – 80% of the load on the forefoot, which contributes to the formation of transverse flat feet, deformation of the toes, and, as a rule, the development of an ingrown toenail.

Exit: Do not abuse the constant wearing of dress shoes with high heels.

Technically incorrect and low-quality pedicure

Promotes the development of local inflammation, the growth of granulation tissue (“wild meat”), secondary bacterial colonization and ultimately leads to the appearance of infectious complications, up to osteomyelitis of the nail phalanx.

Overweight

If the nail plate is overweight, there is no chance for proper growth, and when walking, it will certainly injure the periungual ridge, which is one of the reasons for the development of an ingrown nail.

Exit: to fight the cause, namely, excess weight, because it is dangerous for a number of concomitant diseases (diabetes, metabolic syndrome, arterial hypertension, etc.).

Pedicure

It is no secret that many chemicals used in some beauty salons (acetone, formaldehyde, xylene, etc.) when performing pedicures and nail extensions cause depletion of the nail plate and its detachment from the actual nail bed. This very often becomes a trigger for future complications. A detached and deformed nail plate rarely restores its structure in the future, and sometimes loses its connection with the nail bed forever, which significantly affects the beauty of the nails.

Exit: take care of yourself and do not abuse salon procedures where aggressive chemicals are used.

Household injury of fingers

As a result of trauma, onychoblasts (growth cells) migrate in different directions of the soft tissues of the nail phalanx, thereby provoking uncontrolled growth of the matrix (nail root) and the nail plate.

Exit: In case of injury, seek surgical care in a timely manner, without waiting for complications in the form of an ugly deformity from a newly growing nail plate.

There are many ways to treat an ingrown toenail:

1. Conservative.
2. Operational.

The choice of a specific method is largely determined by the stage of the disease at which the pathological process is located. It is very important to understand that conservative treatments are effective only in the early stages of the disease. But if the ingrown nail is accompanied by pain and inflammation, especially in combination with suppuration, it is urgent to consult a surgeon.

CNMT has developed and implemented a method for treating ingrown toenails, which can significantly improve the quality of human life and forget about this disease forever.